An Interdisciplinary Code Sepsis Team to Improve Sepsis-Bundle Compliance: A Quality Improvement Project

• Published in: Journal of emergency nursing 2020-01, Vol.46 (1), p.91-98
• Main Authors: Delawder, Jill M., Hulton, Linda
• Format: Article
• Language: English
• Subjects: Antibiotics; Blood; Charges; Code sepsis; Communication; Compliance; Computerized medical records; Emergency department; Emergency medical care; Emergency services; Health records; Interdisciplinary; Interdisciplinary aspects; Intervention; Laboratories; Mortality; Mortality rates; Nursing; Paging; Patients; Pharmacists; Physicians; Quality; Quality control; Quality improvement; Quality management; Resuscitation; Sepsis; Sepsis alert; Septic shock
• ISSN: 0099-1767; 1527-2966
• DOI: 10.1016/j.jen.2019.07.001

Sepsis is one of the leading causes of mortality, with more than 700,000 hospitalizations and 200,000 deaths annually. Various tools exist to aid in the early identification and treatment of sepsis, including electronic alert systems, standardized order sets, nurse-initiated protocols (NIPs) and specially trained teams. Despite available guidelines, mortality rates for severe sepsis and septic shock are near 50%. The aims of this rapid cycle quality improvement project were to develop and implement an interdisciplinary team to address early implementation of sepsis bundles in the emergency department and to compare sepsis bundle compliance 3 months pre- and 3 months postintervention implementation. The population included all patients above 18 years of age presenting to the emergency department with clinical indications of sepsis, severe sepsis, or septic shock. Data were collected via electronic health records (EHRs), switchboard-paging records, and a billing database. The pre-post intervention analysis shows an improvement in time to each bundle element except antibiotics and completion of blood cultures. There were noteworthy changes in meeting bundle compliance in fluid resuscitation volume (χ2 = 16.3, P ≤ 0.001): initial lactate collected within 180 min (χ2 = 11.3, P ≤ 0.01) and time to second lactate within 360 min (χ2 = 27.7, P ≤ 0.001). Mortality rates showed a steady decline from over 12% to 5%. No differences were found in mortality rates related to age or gender. Interprofessional teams can use existing knowledge, skills, and tools to improve sepsis-bundle compliance and mortality outcomes in patients with sepsis presenting to the emergency department.